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Using the most common office visit, CPT code 99214, determine the reimbursement from the Centers for Medicare and Medicaid Services (online fee schedule available for Medicare).

You are assessing the payer–patient mix for a health care organization. Currently, your payer mix is 40% Medicare, 10% Medicaid, 25% traditional indemnity insurance, 20% managed care, and 5% self-pay patients. Complete the following:

  • Using the most common office visit, CPT code 99214, determine the reimbursement from the Centers for Medicare and Medicaid Services (online fee schedule available for Medicare).
  • Using the same CPT code, 99214, determine the reimbursement for Medicaid (fee schedules should be available from the individual state).
  • Using the same CPT code, 99214, create at least 3 other traditional indemnity insurance reimbursements. If possible, use the actual reimbursement from the insurance carrier. It may be possible to obtain actual reimbursement information from your personal insurance carrier. If the information is not available, assume reimbursement by traditional indemnity insurance is usually 200% reimbursed more than Medicare and Medicaid, and managed care is usually 133% more than Medicare and Medicaid.
  • Compose an accounts receivable benchmark from this information showing columns for current, 30–60, 61–90, 90–120, and greater than 120 days.
  • Assess the information for areas of improved reimbursement of at least 20% or more.
  • Evaluate the options available to change the payer–patient mix with consideration of related legal and ethical issues.
  • Propose a best strategy with justification and rationale based on effective decision-making tenets.

Outline improvements that should be made to the waiting room that help assist the patients.

  • Patients Information in EHR System
    • Describe the process for entering the patient’s information in the Electronic Health Record. Summarize the importance of this process being accurate
  • Appointment Follow-up
    • Outline the steps for following-up with the patient after their appointment
  • Identify Patient Waiting Room Improvements
    • Outline improvements that should be made to the waiting room that help assist the patients
  • Describe Patient Relation Improvement Techniques and Policy Creation
    • Summarize the policies the office should have for patient’s without appointments, managing patients’ wait time, and registering patients

Identify inefficiencies in the way that human resources are utilized in a business at which you have worked in the past or with which you are familiar.

Investigate the degree to which human resources are related to the other factors (project management, product design, process strategy, location decisions, layout decisions, etc.). In a 3- to 4-page Microsoft Word document, address the following:

  • Identify inefficiencies in the way that human resources are utilized in a business at which you have worked in the past or with which you are familiar.
  • Describe ways in which the inefficiencies that you have identified could be reduced or eliminated.
  • Define what changes would be required to job designs in order to implement your suggested strategies for eliminating the inefficiencies.
  • Identify how the way people are measured might need to be adjusted as a result of your suggestions.
  • Explain whether additional compensation might need to be offered as a result of your plan to change job designs and work measurements. Support your rational with examples.